Healthcare on the brink of revolution

Pundits have been saying for years that healthcare is on the cusp of major disruption. However, the delivery of healthcare around the world has proven stubbornly resistant to change — we are still waiting at clinics as our parents did, we are still undergoing tests we do not understand and we still receive bills we cannot make sense of. There have been many false starts for change, but this time, it is real and there are three reasons.

The first reason is politics and how governments today have to manage growing demands from citizens for universal healthcare. Universal health coverage has been advocated by many governments since the World Health Organization’s (WHO) 1978 declaration of “Health for all”.

But it has been largely rhetoric rather than reality in the past three decades, and in the furious rush for riches, access to healthcare instead worsened.

For example, China’s hugely successful barefoot doctors scheme has fallen apart because of lack of funding and professional interest, with attention turned to urban hospitals and medical specialisation instead.

Today, universal coverage, described by WHO Director General Margaret Chan as the “most powerful concept public health has to offer”, is back in vogue. Indonesia is implementing Jaminan Kesehatan Nasional (JKN), its version of universal healthcare, while Singapore has expanded MediShield to MediShield Life. The voices of the people have big sway now and “access” and “equity” are key words today.

Second, there is a critical need for sustainability in healthcare and new financing models.

While governments understand the need to do more for more citizens, they are also concerned that the comprehensive welfare models that dominated post-war Europe are running into severe financial headwinds. Insurers and employers are likewise worried at the double-digit year-on-year increase in healthcare claims.

There is common agreement that the situation cannot persist and radical surgery to the financing model is needed.

Third, there is a desperate shortage of healthcare resources globally. The world is short of 7.2 million health professionals today and this will worsen to 12.9 million by 2035, according to the WHO. No country in the world is spared these shortages.

In the developed world, the need for healthcare is growing because of ageing and chronic diseases; in the emerging economies, the rise of the middle class and demand for quality healthcare make the global shortages even more acute.

Taking these observations collectively, it is clear the status quo is doomed to fail operationally, financially and politically. New models to deliver better care at lower costs to more people are urgently needed.

CAN TECHNOLOGY SAVE HEALTHCARE?

Tremendous strides in technology, particularly information and communications technology enable innovative solutions to be found in response to the formidable challenges described above. Digitalisation permits the healthcare value chain to be taken apart and care delivered where it is most cost-effective.

For example, X-rays taken in America can be read in India at lower costs and faster turnaround times. Digitalisation also allows compilation and analyses of vast amounts of data (what is often termed “Big Data”) which enable doctors to understand patients much better and work proactively to prevent illness and maintain health.

In the same way, Google’s algorithms are so finely tuned it almost seems to know what one is searching for from the first letter typed into its search engine, can the health system identify and proactively manage patients before they run into trouble?

Add to that the potential of wearable devices, including Apple’s technology-laden smart watch, and the possibilities are immense. More mundanely, data also allows better deployment of existing resources.

The Singapore Civil Defence Force, for instance, is looking at big data to predict demand and better deploy emergency resources such as ambulances and fire engines.

The milieu is ripe for reform: Health ministers are compelled by their citizens to expand access but are also cognisant of shortages in manpower and infrastructure, finance ministers are kept awake at night by worries of how to pay for the needed healthcare, and citizens will not wait decades for change.

To square the circle, incremental efforts such as more efficiently managing waiting times, expanding numbers of doctors and hospitals will be necessary but insufficient.

The gaps are simply too wide. Indonesia, for example, has one-tenth the number of doctors per capita Singapore has. Singapore has proportionately less than half the hospital beds of OECD countries. The list of constraints goes on and on.

Radical transformation is needed; and this time, the forces of change may be too great for the status quo to remain.

ABOUT THE AUTHOR:

Dr Jeremy Lim is head of the health and life sciences practice for the Asia-Pacific for Oliver Wyman, the global consultancy. He is the author of Myth Or Magic: The Singapore Healthcare System. This is the first of a two-part series. Watch out for Dr Lim’s commentary on how Singapore can ride the healthcare revolution in our paper tomorrow.